MEDICARE: HANNAH MELISSA KOCH OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1063990117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH MELISSA KOCH OT

Provider Business Mailing Address
First Line	:	1935 N LOGAN ST APT 1009
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-4438
Country	:	US
Telephone Number	:	802-371-7913
Fax Number	:

Provider Business Practice Location Address
First Line	:	1958 ELM ST RM 310
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-1247
Country	:	US
Telephone Number	:	802-371-7913
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2018
Last Update Date	:	07/31/2018

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